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Psychiatric hospitalization characteristics associated with insurance type

ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第4期25卷 437-448页

作者： Hendryx, MS DeRyan, J Washington State Univ Washington Inst Mental Illness Res & Training Spokane WA USA Washington State Univ Dept Psychol Spokane WA USA Washington State Univ Program Hlth Policy & Adm Spokane WA USA

This study examines the relationship among types of insurance and characteristics of inpatient psychiatric treatment. Data include 46,998 adult psychiatric or substance abuse cases from all 1991-1992 Washington State discharges from short-stay general hospitals. Large and significant differences among payers exist in treatment characteristics, controlling for diagnosis and patient age. For example, length of stay is longest among commercial and Medicare payers. Emergency admissions are more common among public payers, and elective admissions are more common among private payers, including HMOs, Results are discussed in light of policy and administration issues that will arise as financing for mental health services comes under greater capitation.

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The use of general practitioner elderly beds in community hospitals

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AGE AND AGEING 1998年第6期27卷 753-753页

作者： Rhodes, KM Qureshi, AS Foulkes, H Orpington Hosp Acad Dept Med Elderly Orpington BR6 9JU Kent England James Paget Hosp Dept Med Great Yarmouth England

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Day versus inpatient treatment for cocaine dependence: An experimental comparison

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第2期23卷 234-245页

作者： Schneider, R Mittelmeier, C Gadish, D HARVARD COMMUNITY HLTH PLAN SUBST ABUSE SERV BRAINTREE CTR CHILD & FAMILY TEAM BRAINTREE MA 02184 USA

This study was designed to explore the question of whether day treatment is a viable alternative to inpatient treatment for cocaine-dependent patients. Inpatient subjects were compared with day-treatment subjects in a randomized, prospective study design. Treatment outcome was evaluated at three and six months posttreatment. At three months posttreatment, the inpatient group had a statistically significant higher rate of total abstinence than the day-treatment group, but the difference at six months was not statistically significant. The two groups also were statistically comparable at six months posttreatment in terms of ''current'' abstinence and in terms of other measures. Average costs for day-treatment subjects was 48-61% of the cost for inpatient subjects. The results of this study support the use of day treatment as a clinically and economically effective alternative to inpatient treatment for many cocaine-dependent patients, especially when steps are taken to minimize drop out.

关键词：出院后医疗/利用波士顿可卡因数据收集日间住院医疗/统计学和数值数据随访研究住院/统计学和数值数据病人依从病人满意度社会经济因素物质滥用治疗中心/经济学物质滥用治疗中心/利用物质相关性障碍/治疗治疗结果成年人女(雌)性人类男(雄)性

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PEDIATRIC DISCHARGE AGAINST MEDICAL ADVICE IN BOUAKE, COTE-DIVOIRE, 1980-1992

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HEALTH POLICY AND PLANNING 1995年第1期10卷 89-93页

作者： GLOYD, S KONE, A VICTOR, AE HLTH ALLIANCE INT SEATTLEWA CHR BOUAKE INPATIENT PEDIAT WARDBOUAKECOTE IVOIRE

Discharge information was obtained from pediatric ward logbooks of the Centre Hospitalier Regional de Bouake from 1982 to 1992. While number of children admitted per month and discharge diagnosis remained relatively stable throughout the period, the proportion of children who left the hospital against medical advice increased by nearly 5 times during the 11-year period to over 12% of all pediatric admissions. The proportion of discharges against medical advice decreased to 10% of ail pediatric admissions after institution of a programme to provide essential drugs at cost to patients (previously only available from private pharmacies). Most children who were taken from the hospital left within the first two days of hospitalization. The admission diagnoses of these children suggest that most had serious, life-threatening illness and that they left the hospital prior to having received adequate treatment. The increase in pediatric ward discharge against medical advice occurred simultaneously with serious budgetary shortfalls in the hospital resulting in inadequacy of medicines and basic equipment. Hospital staff suspected that most of the discharges against medical advice were caused by families being unable to afford the purchase of medicines and supplies necessary for inpatient treatment. it is suggested that widespread policies of decreasing funding for basic curative services in public hospitals may be associated with a substantial increase in preventable child mortality.

关键词：儿童住院/统计学和数值数据患病代价科特迪瓦数据收集发展中国家卫生服务研究医疗费用无力承担中止治疗的病人/统计学和数值数据药剂科医院处方药物/经济学社会经济因素儿童人类

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ECONOMIC INCENTIVES, HEALTH-STATUS AND HEALTH-SERVICES UTILIZATION

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JOURNAL OF HEALTH ECONOMICS 1993年第2期12卷 151-169页

作者： NOLAN, B ECON & SOCIAL RES INST 4 BURLINGTON RDDUBLIN 4IRELAND

The impact on utilisation of differential public entitlements to free health services is analysed, using data for a large sample of Irish households. GP visiting rates are seen to be significantly higher for those on low incomes whose costs are covered by the State than for those who pay for such care, having controlled for other characteristics including health status. The importance of taking differences in health status into account in attempting to distinguish the effects of economic incentives is shown both for GP visits and hospital stays.

关键词：青少年成年人老年人数据收集女(雌)性卫生保健费用/统计学和数值数据卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据健康状况住院/统计学和数值数据人类收入/统计学和数值数据保险健康/立法和法学保险健康/利用爱尔兰最小二乘法分析 Logistic模型男(雄)性医疗补助/立法和法学医疗补助/利用中年人动机国家卫生规划/经济学国家卫生规划/利用诊室就医/统计学和数值数据医师家庭/经济学医师家庭/利用

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THE DETERMINANTS OF THE HOSPITALIZATION OF NURSING-HOME RESIDENTS

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JOURNAL OF HEALTH ECONOMICS 1993年第3期12卷 349-359页

作者： FREIMAN, MP MURTAUGH, CM AGCY HLTH CARE POLICY & RES CTR GEN HLTH SERV INTRAMURAL RES2101 E JEFFERSON STSUITE 500ROCKVILLEMD 20852 USA

A study analyzes the determinants of the probability that an elderly nursing home resident will be hospitalized over the course of a year. A multinomial logistic model is estimated with 4 possible outcomes for the year: 1. hospitalization, 2. dying in the nursing home prior to hospitalization, 3. leaving the nursing home alive prior to any hospitalization, and 4. remaining in the home for a full year without any hospitalization. The Institutional Population Component (IPC) of the 1987 National Medical Expenditure Survey sample of residents as of January 1, 1987, is analyzed. The overwhelming majority of residents (84%) either were hospitalized during their stay or spent the full year undisturbed in the nursing home. Two important results are found for the financial variables. The rate of payment to the home has a significant and negative effect on the probability of a resident being hospitalized, relative to remaining in the nursing home for the full year. For-profit nursing homes are more likely to hospitalize residents.

关键词：数据收集决策组织预测老人疗养院/经济学老人疗养院/组织和管理住院/经济学住院/统计学和数值数据 Logistic模型医护疗养所/经济学医护疗养所/组织和管理病人转诊/经济学病人转诊/统计学和数值数据偿还途径/经济学美国老年人人类

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HIGH-RISK CLIENTS AND MENTAL-HEALTH-CARE MANAGEMENT

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SOCIO-ECONOMIC PLANNING SCIENCES 1992年第2期26卷 103-110页

作者： SCHINNAR, AP ROTHBARD, AB UNIV PENN DEPT PUBL POLICY & MANAGEMENTPHILADELPHIAPA 19104 UNIV PENN DEPT PSYCHIATPHILADELPHIAPA 19104 UNIV PENN SCH MEDPHILADELPHIAPA 19104

A framework characterizing high-risk psychiatric patients by their probability of hospitalization and lengthy stay is introduced. Risk curves are then developed for each patient showing the potential impact of mental health case management on patient risk. Preliminary empirical analysis reveals that although most patients benefit from the case management intervention, some 30% of the client population may face an increase in risk of hospitalization and lengthy stay.

关键词：非洲裔美国人数据收集卫生服务研究/方法住院/统计学和数值数据住院时间/统计学和数值数据精神卫生服务/利用模型统计学病人医疗护理计划/统计学和数值数据费城概率危险因素成年人人类

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RESIDENTIAL AND COMMUNITY TREATMENT SERVICES UTILIZED BY A SAMPLE OF YOUTH WITH SEVERE EMOTIONAL DISTURBANCES

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AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 1992年第6期20卷 799-809页

作者： JULIAN, DA JULIAN, TW MASTRINE, BJ WESSA, P ATKINSON, E UNITED WAY FRANKLIN CITY COLUMBUSOH OHIO STATE UNIV DEPT FAMILY & COMMUNITYCOLUMBUSOH 43210 DAVON GRP COLUMBUSOH

Analyzed case records to determine the costs and service usage patterns for a group of 25 youth randomly selected from the case load of a regional mental health agency. Study participants had extensive histories of publicly supported psychiatric hospitalizations. An average of 36.2 contacts per youth (905 total contacts) with human services providers were documented. Approximately 2 out of every 5 contacts resulted in out-of-home placements. The estimated cost of providing services to the 25 youth exceeded 3 million dollars. The types and costs of treatment services provided to study participants are discussed.

关键词：情感症状/流行病学情感症状/心理学情感症状/治疗社区精神卫生服务/经济学社区精神卫生服务/利用综合保健/经济学综合保健/利用费用效益分析横断面研究住院/经济学住院/统计学和数值数据发病率俄亥俄/流行病学病人医疗小组/经济学病人医疗小组/统计学和数值数据寄托治疗/经济学寄托治疗/统计学和数值数据青少年女(雌)性人类男(雄)性

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PHYSICIAN PRACTICE STYLE VARIATIONS

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SOCIO-ECONOMIC PLANNING SCIENCES 1989年第6期23卷 361-371页

作者： MACLEAN, LC RICHMAN, A DALHOUSIE UNIV DEPT COMMUNITY HLTH & EPIDEMIOLHALIFAX B3H 1Z5NSCANADA

This article studies the variation in physician practice style among geographic regions and across time. A physician practice profile is defined and a simple model for profile variation is developed. Ratios are calculated for the components of the profile—ambulatory visit rate, hospitalization rate and length of hospitalization—and studied in terms of adaptation to resource constraint and nonspecific style. The methods are applied to hospital use in the Census Metropolitan Areas of Canada.

关键词：门诊医疗/利用加拿大卫生服务范围决策评价研究地理学卫生服务易得程度住院/统计学和数值数据住院时间/统计学和数值数据模型统计学医师诊疗模式/统计学和数值数据

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INSURANCE ASPECTS OF DRG OUTLIER PAYMENTS

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JOURNAL OF HEALTH ECONOMICS 1988年第3期7卷 193-214页

作者： KEELER, EB CARTER, GM TRUDE, S RAND CORP 1700 MAIN STSANTA MONICACA 90406 USA

As part of the prospective payment system, the government pays 'outlier' payments for especially long or expensive cases. These payments can be viewed as insurance for the hospital against excessive losses. They mitigate problems of access and underprovision of care for the sickest patients, and provide additional payments to the hospitals that take care of them, thereby making payments to hospitals more equitable. This paper characterizes the outlier payment formulae that minimize risk for hospitals under any fixed constraints on the sum of outlier payments and minimum hospital coinsurance rate. We then simulate per-case payments for a policy that did not include any outlier payments, the current outlier policy, and several other policies that minimize risk subject to different coinsurance constraints. The current outlier policy achieves each of its goals to at least some extent, but more insurance could be provided without lessening attainment of the other goals. We also discuss some problems with the implementation of the current policy, such as its reliance on day outliers.

关键词：保险统计分析 Medicare与Medicaid服务中心(美国) 绝对免赔额与共同保险诊断相关患者组/经济学经济学医院/统计学和数值数据保险住院/统计学和数值数据 Medicare 模型统计学预期支付系统/组织和管理危险因素美国

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